This week at clinical, the patient I focused on was a 22 year old male who came to Methodist Specialty and Transplant on February 8, 2016. This patient has been in the hospital for almost a month because his mother, a nurse, wanted him to stay until he gets better. This patient came into the hospital because for the week prior to his admittance, he was increasingly becoming more and more aggressive towards his mother and younger sister. He told the emergency department that he had just changed medications and that the new medication was making him aggressive. The patient also said that the aggression is triggered by feeling unsafe in certain environments and that he is hearing voices which were telling him that he was “neurotypical.” When speaking to the nurse about how they are planning care for this patient, she described to me that “we want to decrease his disturbed thoughts and help encourage him to engage in recreational therapy. We also want to monitor his mood.” Many times, I would see the patient pacing up and down the halls muttering. He would walk his room, close the door, and come back out and start pacing again. Another patient seen on the male side was an older male who came in through the emergency department with catatonic schizophrenia. He learned through his time at the hospital that he can get shots of Ativan to perk up and he tried his hardest to make sure that he got it. At first, he wouldn’t wake up when the tech and I went into his room. I thought that he was simply tired, but Stephanie went and pulled the blanket off of this patient. We then discovered that the patient had wet the bed and needed to take a shower. After Donniqua and I helped Stephanie with this patient, he sat down and ate his breakfast. When it was time for meds, this patient refused oral medications by spitting them into the toilet after trying for what seemed like ten minutes. I’m sure that the medications left a nasty taste if they had been in his mouth for that long. A few hours afterwards, the patient became very fixated on trying to get into the nurses’ station. He would make a dash for the door anytime someone would come through with meds or the med cart. Many times, it took 2 to 3 people to stop him and get the door closed. Eventually the nurses were able to redirect him and he stopped charging the door.
If I could change that day, I would change how Stephanie reacted to the patient who refused the meds. The techs on each floor are very interactive with all of the patients and I was somewhat upset with how she reacted when he spit up his medications. She stormed out of the patient’s room and left the floor to take a smoking break. She left Donniqua and me alone so she could take her break. It took her about an hour to calm down. Within that time, MJ had taken us under her wing and we helped her with the female side. I think that the patient’s later outburst was caused my Stephanie storming out of his room. Both could have reacted in a different way and there would’ve been less confrontations. When looking back, I wonder that if I knew more about psychiatric nursing if I could have or should have helped the other nurses when it came to keeping the patient out of the nurses’ station. Would I have been help or would I have been in the way? Of course, being a student, it was a little overwhelming watching them handle this patient, but I also feel that there are more volatile patients who come to the acute floor. To improve my future nursing practice, I would like to use a more therapeutic communication style when it relates to given medications, especially if I work in the psychiatric unit. It is important for patients to have their medications, but I feel there is a more efficient way of encouraging and informing patients about taking their medications. When another circumstance happens like this again, I will make sure to keep my composure as well as be as informative as I can and to help encourage medication compliance.